Preliminary results from two ongoing Ontario studies suggest
that a bacterium responsible for a widespread disease in cattle, survives
pasteurization. Researchers have suspected for almost twenty years that
a bacterium responsible for causing a gastrointestinal disease in cattle
may also play a major role in the development of Crohn's disease in humans.
The problem to this day remains to prove the theory. The bacterium may be
transmitted from animals to humans through pasteurized milk. Public Health
authorities are increasingly preoccupied by the possibility of such a link.
The dairy industry is facing scientific evidence that is controversial and
because uncertainties abound, there is no consensus to know whether a causal
link in fact exists between the bacterium and the human disease. Nonetheless,
a mere suggestion that milk may not be exempt from this bacterium represents
a potential nightmare for marketing of this consumer food.

The Association of dairy producers in Ontario is financing two
studies being carried out by the Department of Microbiology at Guelph University
in Ontario. One study analyses samples of retail milk that have been injected
with the bacterium "Mycobacterium avium subspecies paratuberculosis"
or Map as it's known in the jargon of microbiology. The samples are then
pasteurized in the lab. The second study consists of analyzing samples of
commercially pasteurized milk. In both cases, they want to know whether
the pasteurization process succeeds at killing the bacterium. Wes Lane,
research director for the association, explains what prompted the dairy
producers to finance such studies: "First of all, there is the economic
impact of bovine paratuberculosis that is becoming progressively more common
in dairy herds. And furthermore, the possibility that a link between milk
and Crohn's disease is ever determined worries the Ontario dairy industry.
It would be a catastrophe if the public lost confidence in their milk."

Wes Lane and Joseph Odumeru, microbiologist responsible for
the studies, maintain that no test results are presently available. Even
so, a document from Health Canada dated last December 14th makes mention
of preliminary results. The document from the Food Risk Agency of Health
Canada in fact indicates that milk samples from the two studies being performed
at Guelph University, have tested positive for the presence of the bacterium
Map. In what proportion is this bacterium present can only be determined
by studies that are more extensive. Joseph Odumeru admits that this is a
very delicate subject and that Guelph University has agreed to discuss the
results with Ontario's dairy producers before making them public.

And if the final test results are positive that in fact the
bacterium was present in milk? What would be the next step? Wes Lane doesn't
want to anticipate what decisions would be taken at that moment. What is
certain though is that the results would elicit much interest on the part
of the dairy industry, but also on the part of the organization responsible
for public health in this country, and that is Health Canada. Stacey Mantha,
biologist at the Infectious Disease Branch of Health Canada, is well acquainted
with the bacterium that is presently being studied most everywhere in the
world. "I've participated in discussions where there was question of
national investigation of retail milk, like the studies recently concluded
in the UK (last year). For the moment though, nothing's in the works."

Tracking A Bacterium

Canada's
not the first country to search for the presence of this germ in pasteurized
milk. Since 1993, there have been seven major studies in Europe and in the
United-States. Five of them reported that the bacterium survived pasteurization.
Between 1990 and 1998, the American National Medical Library lists 27 research
papers of international significance, on the possible link between Crohn's
disease and MAP. These are investigations, which have generally arrived
at contradictory results.

Health Canada has followed the studies for at least seven years.
In 1994, the Food Risk Agency of Health Canada draws up an internal document
stamped in English: "Protected, not for distribution". There is
question of Mycobacterium paratuberculosis as agent responsible for Crohn's
disease and milk as possible vector of transmission and cause for concern
for public health. The following year, Agriculture and Agri-Food Canada,
in conjunction with Cornell University in New-York State, mounts a study
of non-pasteurized milk samples coming from southern Ontario, to try to
detect the microorganism. Scientists do not detect the bacterium. At that
time, methods for isolating and identifying this bacterium are not very
sophisticated. Since 1997, American and European studies have proved that
the bacterium can survive pasteurization.

Official results from the ongoing studies at Guelph University
will be known later this year. We will then know if retail milk is free
of the bacterium. The Ontario dairy industry would like to be free of this
nagging issue. And with cause: 81% of dairy resources are situated in Ontario
and Quebec. Canada's dairy industry ranks 3rd in importance in agriculture
after cereals and red meat. In 1999, it was an industry worth 4 billion
dollars.

Pasteurized
Milk and Crohn's Disease,A Link That
Scarcely Raises A Hint of Concern in Quebec

Dr Jean
Lachance, gastroenterologist at Sainte-Justine Hospital, says that there
is no need for undue concern at this moment: "Each year I participate
in many scientific conferences and this link between bacterium, pasteurized
milk and Crohn's disease is far from unanimously accepted. Even if I had
a young patient coming from a family where Crohn's disease already exists,
I would certainly not advise him to stop drinking milk. Not at all."
Are the dairy
industry and the Ministry of Agriculture for Quebec (MAPAQ) worried
about the presence of this bacterium in milk? The role of the Quebec Federation
of dairy producers is similar to that of the Association of dairy producers
of Ontario. Jean Vigneault, director of communications for the Federation,
had few comments on the issue. "I must inform myself before answering
on a subject that, for the moment, means nothing to me." Something
that he did. He declares that the Federation will follow the problem closely.
As for the
Council for the Quebecs dairy industry, its main responsibility is
the economic development of the industry. Its president, Claude Lambert,
emphasizes that it's not up to the Council to set quality controls in order
to certify that milk poses no danger to the consumer. The responsibility
for those controls falls on the Ministries of Agriculture, both at the federal
and at the provincial levels, through their inspection agencies. He confirms
however, that whatever can impact negatively on the dairy industry concerns
them. During the interview, Mr. Lambert acknowledges that it's the first
time that he hears of a possible link between this cattle disease and Crohn's
disease.

National Studies in the UK

On the government side, the inspection agency for the Ministry
of Agriculture in Quebec (MAPAQ), is responsible for the inspection
of milk and dairy products destined for sale inside Quebec. Michel Houle,
operations advisor, keeps abreast of scientific research, however controversial,
on the role that this bacterium may play in Crohn's disease. His department
hasn't contemplated doing any studies to test for the bacterium in milk
sold in Quebec. "We are waiting to see, in part, the final results
of the British tests," said Michel Houle. Preliminary
results from the national tests in the UK showed last autumn, that 3% of
samples of commercially pasteurized milk, originating from approximately
800 British dairies, contained the bacterium. The Food Research Institute
in the UK is analyzing the report and will present the final results at
a conference later in the spring. In the meantime, the institute recommends
that the public not change its milk consumption. Réjean
Bouchard, president of Canada's dairy producers, asks himself: "To
begin with, did the British dairies do their job well, according to regulations?
I believe that in North America, we do better than over there."

Paratuberculosis

If there's a risk that the bacterium that causes bovine
paratuberculosis can find its way into milk destined for human consumption,
we must try to control the disease in cattle. Michel Major, veterinary for
the Ministry of Agriculture, is about to undertake an investigation of dairy
herds in Quebec in order to learn how widespread bovine paratuberculosis
has become at home. In the US, the Federal Bureau of Agriculture has disclosed
that 41% of dairy herds of more than 300 animals were infected with paratuberculosis.
Investigations in the Maritime Provinces in 1998, and in Ontario in 1999
give similar results. Michel Major states that in spite of differences in
investigative methods from one area to another, "there is no reason
to believe that our results will be very different from those found elsewhere
in the world".

Living with Crohn's Disease

We still don't know what causes the disease that carries the
name of the researcher who first identified it in 1932. We know that it's
a chronic disease that can be devastating in its episodes of severe diarrhoea
that lead to substantial weight loss. It attacks mostly the young in early
adulthood and people after their sixties. Scientists seem convinced of one
thing however: this disease is not "mono-factorial" which means
that it is most probably caused by multiple factors. It is possible that
it is triggered by an abnormal reaction to a bacterium or a virus. A reaction
that could be triggered by a genetic predisposition, but that hypothesis
has not been proved either.

Studies that could tell us how many people suffer from this
disease in Canada are few in numbers and mostly regional. In 1994, a study
in Manitoba revealed almost 200 cases of Crohn's disease per 100 000 population.
This represents the highest incidence ever published in the world. In comparison,
there are 60 cases per 100 000 population in the UK, 34 in Australia and
6 in Japan. The Canadian Crohn's/Colitis Foundation, in collaboration with
researchers from every province, including Quebec, is presently establishing
a registry for Crohn's patients. This registry will give a more accurate
picture of the number of Canadians suffering from the disease.

The Foundation estimates that at this moment, there are app.
100 000 Canadians with inflammatory bowel disease. Gilles Demers is 20 years
old when he's told that he suffers from Crohn's, a disease with no known
cause and no known cure. "I cried all day when they announced the diagnosis",
says this man from the Sherbrooke region, now 39 years old. Four surgeries
performed in the early 80's have resulted in his having today only 2 meters
of intestine instead of 6 meters. His inability to absorb nutrients properly
necessitates his using a tube at night in order to feed himself. "The
first 10 years were very hard", remembers Gilles, now married and father
of two children. After periods of flares and then convalescence, he eventually
has to stop working indefinitely. He's in remission now for the last 9 years
and receives a disability pension from Quebec. Gilles' case is pretty severe.
People with Crohn's disease can have symptoms that are less severe than
Gilles' but all suffer a lifetime of flares and remissions.

Similarities with the
bovine disease

American and British scientists wanted to establish a link between
the bacterium that causes paratuberculosis in cattle and Crohn's disease
in humans, precisely because the symptoms bear such striking similarities.
Dairy cows or beef cattle present the following symptoms: severe inflammation
of the intestinal wall and severe diarrhoea and weight loss. In 1984, the
American microbiologist Rod Chiodini, then at the University of Connecticut,
was the first to succeed in isolating the bacterium from the intestines
of Crohn's patients. During this same period, Professor John Hermon-Taylor,
chief of surgery at St George Hospital in London, discovers a DNA sequence
unique to the bacterium that will facilitate identification of the bacterium
in both Crohn's tissue and in milk. "Because after many discussions,
John and I arrived at the conclusion that milk would be the most plausible
carrier between animals and humans, but there can also be water and ground
meat", remarks Rod Chiodini during the interview. For John Hermon-Taylor,
after 20 years of research, "there is no more doubt, this bacterium
that causes a disease in cattle also plays a role in Crohn's disease. Let's
at least assure ourselves that milk is safe", he states during a telephone
conversation. Herbert Van Kruiningen, professor of pathobiology at the University
of Connecticut, is an old colleague of Rod Chiodini. "We were on a
good track there during the 80's but as for me, the scientific community
failed to repeat the experiment in a satisfactory way" he concludes
when contacted on the subject. For him, science was not able to prove that
there is a common cause between the bovine disease and the human disease,
in spite of apparent similarities between the two diseases.

This debate,
which is not settled among the scientific community, has nonetheless caught
the attention of Nicole Fréchette. Her son developed Crohn's disease
just as he was entering university. Nicole, originally from Quebec, has
been living in British Columbia for many years. Having made a career in
nursing, she was able to navigate the scientific documents with a certain
ease. It's during this search that she discovered the Internet site PARA
(Paratuberculosis Awareness and Research Association).

PARA is an
international organization that was established in 1997 by 2 American mothers,
one from Ohio and the other from Florida. These mothers share a common bond
in both having a child who suffers from Crohn's disease. PARA is actively
lobbying the diverse government agencies in the US for funds to be earmarked
for research into an infectious aetiology of Crohn's disease and for testing
of retail milk. Last March 13, Cheryl Miller, co-president of PARA, addressed
the American Congress to request allocation of 500 million US, the amount
required to mount extensive research on this bacterium and on retail milk.
It will be next September before allocation of research funds are announced
by Congress but nonetheless, members of Congress have publicly indicated
that they will give their request very serious consideration.